Combined Surgical and Endoscopic Approach for Ring-Sling Complex.

Background: Left pulmonary artery (LPA) sling (PAS) is a vascular ring, which is frequently associated with long-segment tracheal stenosis (TS). Mortality rate in operated children is still high, especially in cases of severe tracheal hypoplasia and/or associated congenital heart defects (CHDs). We report our experience of treatment and follow-up in a pediatric cohort of patients affected by PAS with severe tracheobronchial involvement.

Tracheal surgery in children: outcome of a 12-year survey.

Objectives: Despite the fact that team management has improved the results in recent years, perioperative deaths and complications remain high in paediatric tracheal surgery. We reviewed our institutional experience by comparing our results with those in the literature.

Methods: Between 2005 and 2017, 30 children underwent surgery for tracheal disease.

Outcome of long-term complications after permanent metallic left bronchial stenting in children.

Objectives: We describe the way we treated 7 children with critical long-term complications after metallic balloon-expandable stenting in the left mainstem bronchus.

Methods: Endoscopic follow-up included a first bronchoscopy 3 weeks after stenting, then monthly for 3 months, every 4-6 months up to 1 year and at scheduled times to calibrate stent diameter up to final calibration. When major complications occurred, patients underwent chest computed tomographic angiography.

Airway stenting in a child with spondyloepiphyseal dysplasia congenita: 13-Year survival.

We describe the case of a boy with spondyloepiphyseal dysplasia congenita. At birth, he experienced severe respiratory distress necessitating tracheotomy. Endoscopy done because mechanical ventilation failed to resolve desaturations disclosed severe tracheo-bronchomalacia.

The role of posterior aortopexy in the treatment of left mainstem bronchus compression.

Objectives: We reviewed the role of posterior aortopexy for left mainstem bronchus compression in infants and children.

Methods: Eighteen children with respiratory symptoms were enrolled between 2005 and 2015 for surgical decompression of the left mainstem bronchus. The children were managed from diagnosis to follow-up by a dedicated tracheal team.

Efficacy of ketamine in refractory convulsive status epilepticus in children: a protocol for a sequential design, multicentre, randomised, controlled, open-label, non-profit trial (KETASER01).

Introduction: Status epilepticus (SE) is a life-threatening neurological emergency. SE lasting longer than 120 min and not responding to first-line and second-line antiepileptic drugs is defined as 'refractory' (RCSE) and requires intensive care unit treatment. There is currently neither evidence nor consensus to guide either the optimal choice of therapy or treatment goals for RCSE, which is generally treated with coma induction using conventional anaesthetics (high dose midazolam, thiopental and/or propofol).

Ketamine in refractory convulsive status epilepticus in children avoids endotracheal intubation.

Objective: The purpose of this study was to report on the efficacy and safety of intravenous ketamine (KE) in refractory convulsive status epilepticus (RCSE) in children and highlight its advantages with particular reference to avoiding endotracheal intubation.

Methods: Since November 2009, we have used a protocol to treat RCSE including intravenous KE in all patients referred to the Neurology Unit of the Meyer Children's Hospital.

Results: From November 2009 to February 2015, 13 children (7 females; age: 2 months-11 years and 5 months) received KE.

Ground zero: not asthma at all.

Upper airway obstruction is commonly misdiagnosed as asthma. We report on four children with recurrent respiratory symptoms who had been erroneously diagnosed as having asthma and who received anti-asthma medication for several years. The evaluation of spirometry tracing was neglected in all cases.

ALCAPA and massive pulmonary atelectasis: how a stent in the airway can be life-saving.

Anomalous left coronary artery from pulmonary artery (ALCAPA) is a rare congenital anomaly in which left coronary artery arises from the pulmonary artery resulting in progressive myocardial ischemia and dysfunction of the left ventricle. We report a case of ALCAPA with severe cardiac and respiratory failure and huge heart dilation compressing the left main bronchus and preventing from an effective ventilation. Emergency bronchial stenting allowed to improve left lung atelectasis, reduce pulmonary hypertension, resume anterograde left coronary artery perfusion and stabilize cardiovascular conditions to undertake a successful surgical correction.

Tracheobronchial obstruction: follow-up study of 100 children treated with airway stenting.

Objective: We described a cohort of 100 children with a wide variety of airway obstruction who underwent stent positioning in the last 7 years. The study examined the outcomes of this treatment in the largest series of paediatric patients reported in the literature with special concern over safety and clinical effectiveness.

Methods: We performed a retrospective analysis of 100 consecutive paediatric patients who underwent stent insertions between January 2005 and May 2012.

Successful simultaneous correction of complex congenital tracheal stenosis and tetralogy of fallot.

Congenital tracheal stenosis is frequently associated with heart malformations. Simultaneous correction of both anomalies has been advocated by several authors. We describe our experience with a premature neonate with congenital tracheal stenosis and tetralogy of Fallot.

Efficacy and safety of ketamine in refractory status epilepticus in children.

Objective: To evaluate the efficacy and safety of ketamine (KE) in the management of refractory convulsive status epilepticus (RSE) in children.

Methods: In November 2009, we started using KE for treating all children consecutively referred for RSE. Clinical and treatment data were analyzed.

Endoscopic anterior cricoid split and balloon dilation in pediatric subglottic stenosis.

Objectives: To analyze the outcome of a new endoscopic approach for the treatment of pediatric subglottic stenosis.

Study Design: Case series.

Setting: Tertiary care center.

Neonatal liver abscesses due to Candida infection effectively treated with caspofungin.

Unlabelled: Candidiasis is relatively frequent in neonatal and pediatric intensive care units (ICUs), particularly in preterm infants less than 28 weeks of gestational age. Neonatal candidiasis shows high mortality and is often associated to poor neurodevelopmental prognosis in survivor patients. Amphotericin B and fluconazole are the first choice drugs for the treatment of neonatal candidiasis.

Assessment of cardiac output in children: a comparison between the pressure recording analytical method and Doppler echocardiography.

Objective: To assess cardiac output in pediatric patients with the pressure recording analytical method (PRAM) and the Doppler echocardiography method. PRAM derives cardiac output from beat-by-beat analysis of the arterial pressure profile (systolic and diastolic phase) in the time domain.

Design: A prospective observational study.

The importance of a multidisciplinary approach in a child with major abdominal penetrating trauma.

We present a case of a 2-year-old girl who had a lawn mower accident with subtotal gut evisceration, multiple ischemic intestinal lesions, hepatic and gastric wounds, amputation of the left forearm, and hypovolemic shock. Prompt and adequate management was carried out in tertiary level institution, based upon quick evaluation of the lesions, fluid resuscitation, surgical repair, and postoperative admission to the pediatric intensive care unit.

Glandular hamartoma of the larynx: report of a case.

Glandular hamartoma is an extremely rare congenital malformation of the larynx. Presenting symptoms result from airways obstruction and may include slowly rising respiratory distress, stridor, changes in voice, eating and activity levels. Management consists in local mass excision with a good functional result and prognosis.